Cost-effectiveness of hearing screening in preschool children: a systematic review

OBJECTIVE: This review synthesises economic evidence for pre-school hearing screening, a debated strategy for detecting hearing loss missed by newborn programs. DESIGN: Following PRISMA guidelines, A comprehensive search of the Cochrane Library, EMBASE, and PubMed was performed from database inception through March 2025. The review included full economic evaluations (cost-effectiveness analyses) reporting cost per Quality-Adjusted Life Year (QALY) or Disability-Adjusted Life Year (DALY). STUDY SAMPLE: Four decision-analytic modelling studies included. The studies were from the United Kingdom, Iran, and Australia, focusing on screening children at or before primary school entry. RESULTS: Evidence synthesis revealed significant heterogeneity. Three studies were cost-effective, while one suggested it was not. This divergence was strongly influenced by methodological factors: the modelled time horizon, the choice of outcome metric (QALY vs. DALY), and the baseline coverage of UNHS. For instance, the Incremental Cost-Effectiveness Ratio for pure-tone screening fell from $5,814/QALY over one year to $401/QALY over an 11-year horizon. CONCLUSIONS: The cost-effectiveness of pre-school hearing screening is highly context-dependent. Key determinants include existing UNHS infrastructure, the chosen screening technology, and the evaluation time horizon. Policymakers must consider these local factors to implement the most economically viable strategy.